UWorld Pediatrics

Cardiovascular
● Tetralogy of Fallot- four related heart defects that are commonly seen together
○ Ventricular septal defect- a hole between the right and left pumping chambers of
the heart
○ Overriding aorta- the aortic valve is enlarged and appears to arise from both the
left and right ventricles instead of the left ventricle in normal hearts
○ Pulmonary stenosis- narrowing of the pulmonary valve and outflow tract or area
below the valve that creates an obstruction of blood flow from the right ventricle
to the pulmonary artery
○ Right ventricular hypertrophy- thickening of the muscle walls of the right
ventricle, which occurs because the right ventricle is pumping at high pressure
○ Repair of this condition typically causes clients to develop chronic pulmonary
regurgitation, resulting in heart failure
■ S/sx of heart failure
● Impaired myocardial contractility: tachycardia, pale/cool
extremities, weak peripheral pulses, decreased BP, decreased
urinary output, activity intolerance, weakness/fatigue, loss of
appetite
● Pulmonary congestion: dyspnea, tachypnea, orthopnea
● Systemic venous congestion: hepatomegaly, peripheral edema,
JVD, weight gain, ascites
○ “Tet spell”- hypercyanotic episodes that occur when oxygenated blood enters
circulation, resulting in cyanosis and hypoxemia
■ Usually occur during stressful or painful procedures, on waking, with
hunger, crying, and feeding
■ Ways to prevent tet spells: providing a calm environment, particularly on
waking, soothing and quieting the infant when crying or distressed,
offering a pacifier, swaddling ot holding the infant during procedures or
times of stress, providing frequent smaller feedings, place infant in a knee
chest position
● Supraventricular tachycardia
○ Commonly reported as a feeling of palpitations in children
○ A vagal maneuver can be performed to correct this if the client is stable to convert
the rhythm
■ Place ice bag on patient’s face and instruct them to bear down
● A diaper rash can delay surgery because it can possibly contaminate the insertion/
surgical site
● Atrial septal defect- an abnormal opening between the right and left atria, allowing blood
from the higher pressure left atrium to flow into the lower pressure right atrium.
 ○ The blood flow back and forth between the two chambers causes vibration and a
systolic murmur on auscultation and a fixed split second heart sound
● Kawasaki’s disease- childhood condition that causes inflammation of arterial walls. Can
cause children to develop coronary aneurysms
○ 3 phases of KD
■ Acute- sudden onset of high fever that does not respond to antibiotics and
antipyretics. Child becomes irritable and develops swollen hands and
feets. Lips become swollen and cracked, and the tongue can become red.
■ Subacute- skin begins to peel from hands and feet, the child remains very
irritable
■ Convalescent- symptoms disappear slowly, the child’s temperature returns
to normal
○ Treatment
■ IV gamma globulin (IVIG) and aspirin
■ IVIG creates signs of fluid overload and pulmonary edema, so they should
be monitored for symptoms of heart failure (decrease urine, additional
heart sounds, tachycardia, difficulty breathing)
○ Patient education
■ When children with KD are discharged, parents are instructed to monitor
them for fever Q6H
● If fever develops, health care provider should be notified
● Patent ductus arteriosus (PDA)- congenital heart defect in premature infants where there
is a vascular structure that connects the proximal descending aorta to the roof of the main
pulmonary artery
○ Treatment: surgical ligation or IV indomethacin to stimulate duct closure
○ S/sx: machine like systolic and diastolic murmur, mostly asymptomatic
● Ventricular septal defect (VSD)- congenital abnormality in which the septal wall is
opened between the left and right ventricles, creating left to right shunting, leading to
excess blood flow to the lungs
○ Risks: CHF and pulmonary HTN
○ If client is showings signs of CHF (ex: grunting), this requires further assessment
for CHF
● An AV canal defect is a common cardiac anomaly associated with trisomy 21
○ Includes a loud murmur upon auscultation
○ Requires no immediate intervention when vital signs are stable
● Infant BLS
○ Thumbs are placed on the third sternum for chest compressions on infants
○ Always check the brachial artery for a pulse during CPR in infants < 1 year
○ Rescuers should check infant’s brachial pulse for no longer than 10 seconds
 ○ Approximately 2 minutes of CPR at at least a rate of 100 compressions/min
before retrieving the AED
○ The rescuer should deliver chest compressions to an infant at a depth equal to one
third of the chest’s anterior diameter and allow for recoil between compressions
○ Single rescuers should perform infant CPR at a 30:2 compression to breath ratio
and a 15:2 ration when two rescuers are involved
Endocrine
● Congenital hypothyroidism- abnormal development of the thyroid gland that causes
complete or decreased secretion of thyroid hormone. Untreated hypothyroidism can cause
severe intellectual disability in infants.
○ Clinical manifestations: lethargy, poor feeding, enlarged fontanelle, protruding
tongue, puffy face, umbilical hernia, constipation, prolonged jaundice, dry skin,
hoarse cry, bradycardia
○ Diagnosis: increased TSH, decreased thyroxine, newborn screening
○ Treatment: levothyroxine
○ Prognosis: no deficits if treatment started in the neonatal period, untreated disease
is associated with neurocognitive dysfunction
GI
● Introduction of solid foods
○ Occurs at 4-6 months
○ When introducing new foods, parents should allow several days between each
new food to observe for any reactions to a specific food
○ After starting iron-fortified cereal (mixed with formula, breast milk, or water),
parents can begin offering soft fruits and vegetables and simple finger foods
● Celiacs disease- gluten intolerance
○ Client teaching: eliminate all gluten from diet (wheat, barely, rye, and oats), rice,
corn and potatoes are gluten free, iron and folic acid replacement, read processed
food labels, gluten free for the rest of their lives, even eating small amounts of
gluten is dangerous
● Lactose intolerance
○ Replace calcium and vitamin D
■ Calcium: beans, dark greens, and calcium-fortified cereals and juices
■ Vitamin D: fish, egg yolks, and vitamin D-fortified foods
● Intussusception- an intestinal obstruction that occurs when a segment of bowel folds into
another segment
○ S/sx: stools mixed with blood and mucus, sudden abdominal pain, drawing the
knees up to the chest, inconsolable crying, sausage shaped abdominal mass
○ Diagnosis: contrast enema (also reduces the intussusceptions)
○ Complications: peritonitis
■ Fever, abdominal rigidity, guarding, and rebound tenderness
● Pyloric stenosis- hypertrophic pyloric muscle causes postprandial (after meal time)
vomiting
○ S/sx: projectile vomiting, olive shaped mass in the epigastric area just to the right
of the umbilicus, emesis nonbilious (formula in/formula out) and leads to
dehydration, infant is hungry constantly, increase Hct/BUN d/t hemoconcentration
caused by dehydration, metabolic alkalosis, hypokalemia
● Iron deficiency anemia
○ Risk factors: insufficient diet intake, premature birth, delayed introduction of
solid foods, consumption of cow’s milk <1 y/o, excessive milk intake (>24
oz/day), exclusion of iron rich foods in favor of milk
○ Treatment: PO iron supplementation, increased consumption of iron rich foods
(leafy greens, red meat, poultry, dried fruit, fortified cereal)
● Hirschsprung disease- occurs when a child is born with some sections of the distal large
intestine missing nerve cells, rendering the interal anal spincter unable to relax. As a
result no peristalsis and stool are passed.
○ S/sx: distended abdomen, will not pass meconium for 24-48H, difficulty feeding
and often vomit green bile
○ Tx: surgical removal of the defective section of bowel and colostomy (possibly)
○ Complications: enterocolitis
■ s/sx: fever, lethargy. explosive/foul smelling diarrhea, rapidly worsening
abdominal distention
● Esophageal atresia and tracheoesophageal fistula- a variety of congenital malformations
that occur when the esophagus and trachea do not properly separate and develop
○ Clinical manifestations: frothy saliva, coughing, choking, drooling, apnea and
cyanosis while feeding, risk for aspiration
● Water intoxication
○ Water overload may occur in infants when formula is diluted to “stretch” the
feeding to save money
○ Hyponatremia may also result from ingestion of plain water
■ S/sx: irritability, lethargy, hypothermia, seizure activity
● Lead poisoning
○ Elevated levels of lead in blood → follow up blood work, assessment of home
environment, handwashing before eating, mop or wet dust hard surfaces, cold
water should be used for consumption if lead plumbing is present
○ Treatment: chelation therapy
○ Can cause neurocognitive impairment
● Infant formula
○ Keep bottles, nipples, caps, and other parts as clean as possible
○ Wash the tops of formula cans with hot water and soap prior to opening to prevent
contamination
 ○ Refrigerate any unused, prepared formula or unused opened formula, but use
within 48 hours or discard to reduce the risk of bacterial growth
○ Warm bottles in a pan of hot water or under warm tap water
○ Test formula temperature on the inner wrist before serving to infant
● Cystic fibrosis- a protein responsible for transporting sodium and chloride is defective
and causes secretions from exocrine glands to be thicker and stickier than normal. These
secretions plug smaller airway passages and ducts in the GI tract.
○ CF diet: high in calories, fat, and protein
○ CF patients cannot tolerate BROW
■ Barely, rye, oats, wheat
○ Tx: nutritional therapy
■ Pancreatic enzyme supplements with or just before every meal/snack.
Children cannot chew these supplements.
● Infant botulism
○ Caused by giving children honey
○ Do not give kids honey
● Physiologic anorexia- occurs when the very high metabolic demands of infancy slow
down to keep pace with the moderate growth of toddlerhood
○ In this phase toddlers are picky
○ Strategies: set and enforce a schedule for all meals and snacks, offer the child 2 or
3 choices of food items, do not force the child to eat, keep food portions small,
expose the child repeatedly to new foods on several separate occasions, avoid TV
and games during meals/snacks
● Hemolytic uremic syndrome (HUS)- life threatening complication of E. coli diarrhea
○ Causes anemia, low platelets, and petechiae or purpura
Growth and Development
● First manifestation of puberty in men: testicular enlargement/sexual maturation
○ Typically occurs from ages 9.5-14 y/o
● Separation or stranger anxiety
○ Occurs when the primary caregivers leave the child in the care of others who are
not familiar to the child
○ Starts around 6 months, peaks at age 10-18
● Growth hormone replacement therapy
○ Used when patient is growth hormone deficient
○ Administered via subq injection
○ Treatment is most successful when diagnosis and replacement therapy begins
early in life, as soon as delays begin
○ Growth less than one inch per year and bone age of 15 in girls and 16 in boys are
criteria to stop therapy
● Developmental milestones for infants and children
● Children beliefs about death
● Nonutritive sucking
○ Helps infant feel secure
○ Sucking should stop before the permanent teeth begin to erupt to prevent the
misalignment of teeth’
● Head lag remaining after 6 months is abnormal and associated with cerebral palsy or
autism
● Shaken baby syndrome- a type of abusive head injury and is defined by the CDC as
severe physical child abuse resulting from violent shaking of an infants arms, legs or
shoulders.
○ Causes bleeding within the brain or eyes
○ Clinical findings are often vague and nonspecific
■ Vomiting, irritability, lethargy, inability to suck or eat, seizures,
lifelessness, difficulty breathing, apnea, and inconsolable crying
■ Usually no external findings except for occasional small bruises on the
chest or upper arms where the child was held during the shaking episode
● Fetal Alcohol Syndrome
○ Leading cause of intellectual disability and developmental delay in the US
○ S/sx: prenatal exposure to any amount of alcohol, growth deficiency, neurological
symptoms
○ Facial features

● Nocturnal enuresis-involuntary bed wetting at night

 ○ Nonpharmacologic strategies: limit caffeine and sugar, void before bedtime, avoid
punishing child, encourage child to assist with changing linens and pajamas,
positive reinforcement, awaken child nightly at a specific time to void, use an
enuresis alarm, prepare a calendar with the child for logging wet and dry nights
● Weight gain
○ Birth weight should double by 6 months and triple by one year
○ During the first year, birth length increases by approximately 50%
○ At birth head circumference is slightly more than chest circumference, but they
equalize by age 12 months
○ By 30 months, current weight should be approximately 4 times greater than birth
weight
● Autism spectrum disorder (ASD)- complex neurodevelopmental disorder characterized
by the onset of abnormal functioning before the age of 3
○ Characterized by abnormalities in social interactions and communication, patterns
of behavior, restrictive and repetitive activities, lack of words/ communication
skills
○ If the child has a sibling
with ASD, then they are
more likely to have ASD as
well
○ Place child in a private room
away from the nursing
station if hospitalized
● Sudden infant death syndrome
(SIDS)- unexpected, unexplained
death of an infant <1 y/o, occurring
most frequently in those <6 months
during naps/ sleep
○ Prevention: sleep on back, firm surface, no stuffed animals, smoke free
environment, up to date on vaccinations, and breastfeeding
● Positional plagiocephaly- flat head syndrome the occurs when an infant’s soft skull us
placed in the same position for an extended period of time
○ Prevention/ correction: frequently alternating the supine infant;s head position
from side to side, minimizing the amount of time an infant’s head rests against a
firm surface, placing pictures and toys opposite the favored side, tummy time
● Failure to Thrive (FTT)- a state of undernutrition and inadequate growth in infants and
young children
○ Physiologic risk factors: preterm birth, breastfeeding difficulties, GERD, cleft
palate
 ○ Socioeconomic risk factors: poverty, social or emotional isolation, cognitive or
mental health disorder, lack of nutritional education, domestic violence, negative
attitudes towards food, unstructured mealtimes, food insecurity
● Marfan Syndrome- autosomal dominant disorder affecting the connective tissues of the
body. Abnormalities are mainly seen in the cardiovascular, musculoskeletal, and ocular
systems
○ Presentation: tall and thin, disproportionately long arms, legs, and fingers
○ Contact sports are discouraged due to the risk of cardiac injury and sudden death
Heme/Onc
● Vaso Occlusive sickle cell crisis- severe pain due to the occlusion of small blood vessels
from increased RBC sickling
○ Tx: pain management, IV fluids, bed rest
○ Splenic sequestration crisis- occurs when a large number of sickle cells get
trapped in the spleen, causing splenomegaly. Can lead to severe hypovolemic
shock
● Iron deficiency is the leading cause of anemia worldwide
○ Foods rich in iron: meat, fish, poultry, foods high in vitamin c
● Epistaxis- nosebleed typically occurring from local injury or irritation
○ Home management: pinch nostrils together, apply a cold cloth to the bridge of the
nose, keep child quiet and calm, tilt head forward
● Hemophilia- a hereditary bleeding disorder caused by a deficiency in coagulation
proteins
○ Treatment: replacing the missing clotting factor (VIII or IX) and teaching the
client about injury prevention
○ Injury prevention: avoid meds with ibuprofen or aspirin, avoid IM injections,
subQ preferred, avoid contact sports, dental hygiene is necessary to prevent gum
bleeding, MedicAlert bracelets should be worn at all times
○ Classic hemophilia or hemophilia A: lack factor VIII
○ Hemophilia B (christmas disease): lack factor IX
○ Monitor for external and internal bleeding
■ Most frequent bleeding sites are the joints, especially the knee
■ Hemarthrosis can occur with minimal to no trauma
● Dehydration
○ Infants and children have a higher percentage of body water than adults, as a
result they become dehydrated quickly due to fluid losses caused by vomiting and
diarrhea
○ S/sx: lethargy, sunken fontanel, increased cap refill, increased HR, increased
respiratory rate
○ Priority: IV rehydration (if dehydration is severe; >10%)
Immune
 ● Varicella immunization- vaccine to prevent varicella zoster (chicken pox)
○ Discomfort, redness, and vesicles at the injection site is common side effects, just
cover with a bandaid
● Allergic rhinitis- a hypersensitivity response to specific triggers (dust, mold, pollen,
animal dander)
○ S/sx: sneezing, nasal drainage, congestion, throat soreness, itching of the
eyes/nose
○ Interventions to reduce exposure: installing high efficiency particulate air
conditioner filters, keeping windows closed, hypoallergenic pillow and mattress
covers, reducing or removing carpet/ area rugs, vacuum carpet at least once with a
HEPA filter vacuum, mopping hard floors and damp dusting furniture at least
once a week
● Appendicitis
○ Once the appendix ruptures, pain is relieved only temporarily and will return with
full blown peritonitis and sepsis
● Tonsillectomy
○ Postoperative bleeding is a primary concern because the surgical site is not easily
visualized and is vulnerable to irritation from swallowing and coughing
■ S/sx of post op bleeding: frequent swallowing or clearing of the throat,
vomiting bright red blood
○ Expected post op findings: ear pain when swallowing, low grade fever, analgesics
(i.e. acetaminophen) may be administered, superficial infection at the surgical site
is common (white, fluid filled exudate in the throat causing halitosis/ bad breath)
● Anaphylaxis
○ S/sx: respiratory compromise (oral and airway swelling, stridor, wheezing, chest
tightness) and shock (dizziness, loss of consciousness)
● Vaccine administration
○ Assess for allergies to vaccine components (neomycin, gelatin, yeast), screen for
allergy to latex (lips swelling from contact with bananas, kiwis, or latex balloons)
○ Severely immunocompromised children (chemo, AIDS, corticosteroid therapy,
IVIG) do not receive live vaccines (varicella-zoster, MMR, rotavirus, yellow
fever)
■ HIV + child → CD4 lymphocyte percentage <15% → severely
immunocompromised
● <750/ mm3 for infants 12 months or younger
● <500/ mm3 for children ages 1-5
● <200/ mm3 for children >5 or adults
Infectious Disease
● Rotavirus- contagious virus and the leading cause of diarrhea in children less than 5 years
old
 ○ Spread via fecal oral route
■ Contact with food, toys, diapers, and hands
○ Handwashing and proper diaper disposal prevents the spread of the virus
○ S/sx: foul smelling, watery diarrhea that lasts 5-7 days, fever, vomiting,
dehydrations (lack of tears, extremely fussy/sleepy, decreased urination, dry
mucous membranes)
○ Vaccine available at 8 months
● Ringworm - fungal infection on the superficial keratin layers of the skin, hair or nails
○ Spread via contact; highly contagious
○ Management: appropriate hygiene (washing hands after touching infected areas),
limited contact with personal items (hairbrush), treatment with the prescribed
shampoos as well as topical/oral medications (terbinafine, miconazole)
● Pinworm
○ Easily transmissible through contaminated good, drink, toys, and linens are
inhaled or swallowed
○ S/sx: anal itching, troubled sleep
○ Tx: antiparasitic meds
● Scabies- highly contagious skin infestation of the sarcoptes scabiei mite
○ Spreads easily via direct person to person contact
○ S/sx: intense itching especially at night
○ Tx: scabicide cream massaged into all skin surfaces form the head to feet. All
persons in close contact with the client during the 30-60 day incubation period
○ Clothing and linens should be washed and dried on the hottest setting
● Fifth disease- viral illness caused by the human parvovirus and affects mainly school age
children
○ Spreads through respiratory secretions
○ S/sx: red rash on cheeks that spreads to extremities, general malaise, joint pain
○ Use ibuprofen to manage joint pain
○ Recovery within 7-10 days
○ Once symptoms develop, children are no longer infectious
○ Isolation is not typically required
● Varicella (chickenpox)
○ Lesions that begin as a maculopapular rash, progressing to weeping vascular
lesions, and typically crust over within approximately 1 week
○ Tx: cool oatmeal baths and topical antihistamines, acetaminophen PRN for
fever/pain
○ Immunocompromised clients are at risk for severe varicella
■ Antiviral therapy until all lesions have crusted over
○ VZV is spread via airborne and contact transmission
■ Most infectious until entire rash reaches the crusting stage
● Reye syndrome
○ Occurs in children who have had a recent viral infection, especially chicken pox
or the flu
○ S/sx: fever, lethargy, acute encephalopathy, altered hepatic function, elevated
serum ammonia, vomiting, altered LOC, seizure, coma
○ Risk increases if aspirin therapy is used to treat the fever associated with
chickenpox or the flu
■ Acetaminophen or ibuprofen used for fever management
● Bacterial meningitis- infection that causes inflammation of the membranes covering the
brain and spinal cord
○ Leads to increased CSF and ICP, which may lead to nerve ischemia, permanent
functional impairment (hearing/ vision loss, paralysis), brain herniation, death
○ Nursing interventions: HOB at 30 degrees, seizure precautions, reduce potentially
irritable stimuli
○ Droplet precautions for clients with meningococcal meningitis
● Group A hemolytic streptococcus- a contagious bacterial throat infection that can lead to
renal or cardiac complications
○ Management: soft diet and cool liquids, complete full course of antibiotics,
toothbrushes should be replaced 24H after starting antibiotics, return to
school/daycare 24H of antibiotics and are afebrile, liquid acetaminophen or
ibuprofen should be given for pain, test siblings age <3 years old
● MMR vaccine
○ Given between 12-15 months
■ However the vaccine is safe for children <12 months. It can provide some
protection or modify the clinical course of the disease if administered
within 72 hours of the child’s initial measles exposure. Immunoglobulin is
administered within 6 days of exposure & is also utilized as post exposure
prophylaxis
○ Fever after vaccination can lead to febrile seizures
○ Instruct parent to monitor the child’s temperature and administer acetaminophen
for a fever above 102F
○ Normal reactions that occur within 5-12 days after vaccination include fever, rash,
irritability, restlessness, swelling/erythema at the injection site
● Pertussis (whooping cough)- very contagious communicable disease caused by the
bordetella pertussis bacteria
○ Spread through coughing, sneezing and close contact
○ Droplet isolation precautions needed
○ S/sx: common cold/ mild fever → violent, spasmodic “whooping” cough and
continue until thick mucus plug is expectorated and are sometimes followed by
vomiting
 ○ Tx: oral antibiotics, humidified oxygen, adequate fluids, suction, monitor
respiratory status for obstruction, positioned on left side to prevent aspiration if
vomiting occurs, vaccinate kids
● UTI
○ Occurs more common in women because of the short urethra and close proximity
to vagina and anus
○ Interventions: wipe from front to back, tell child to not hold urine, avoid
constipation and straining, go to the bathroom right when urge is felt, avoid
scented soaps or commercially prepared bubble bath products, do not use
antibacterial soap when bathing child
● Scarlet fever- a complication of group A streptococcal infection
○ S/sx: red rash beginning on neck and chest that spreads to extremities, resembles
bad sunburn, blanches with pressure, has fine bumps like sandpaper, fever,
exudative pharyngitis, swollen anterior cervical lymph nodes, strawberry tongue
○ Diagnosis: rapid streptococcal antigen test and confirm etiology
○ Treatment: penicillin
● Mono or epstein barr virus
○ Transferred via sharing drinks, kissing, or direct exposure to saliva
○ S/sx: fatigue fever, sore throat, splenomegaly, hepatomegaly, swollen lymph
nodes
○ Tx: antibiotics d/t viral infection, management of symptoms (hydration, rest,
control of pain, reducing fever as necessary, saline gargles, anesthetic troches
○ Complications: airway obstruction, splenic rupture (manifested with severe
abdominal pain)
● Measles
○ Spread through cough or sneeze
○ S/sx: conjunctivitis, koplik spots, coughing, coryza (copious clear mucus),
erythematous morbilliform rash
○ Plan of care: recommendation of post exposure prophylaxis for eligible and
susceptible family members 72 hours of exposure to decrease the severity and
duration of symptoms in case they contract to disease, implementation of airborne
precautions, negative pressure isolation room, administration of vitamin A
supplements
Integumentary
● Pediculosis capitis (head lice)
○ Tx: use of pediculicides and the removal of nits
○ Prevention of spread: hot water to launder clothing, sheets, and towels in the
washing machine (do not place in hot dryer for >20 minutes)
● Atopic dermatitis/ Eczema- chronic skin disorder characterized by pruritus, erythema,
and dry skin
 ○ Teaching: bathing the child with tepid water and mild/ gentle soap, avoid hot
water and long bubble baths, pat the skin dry gently followed by immediate
application of a topical emollient to seal in moisture, giving an oral antihistamine
at bedtime to help relieve pruritus (diphenhydramine, cetirizine), keep nails
trimmed, dress child in soft/ cotton clothing, long sleeves are to be work at night
● Impetigo- highly contagious bacterial skin infection most commonly occurring in
children during hot, humid weather
○ Characterized by itchy, burning, red pustules that rupture to form honey color
crusts
○ Tx: antibiotic ointment and oral antibiotics
○ Lesions are no longer contagious after 24-48 hours, and typically heal within a
week
○ Decrease transmission: performing hand washing before and after touching
infected area, isolation the infected person’s clothing and linens and washing them
in hot water, short fingernails, avoid close contact with others 24-48 hours after
antibiotics, keep infected area covered with gauze when in contact with others
● Cold injury
○ Redness and swelling of the skin and blanched skin with hardness of affected area
○ Rewarm area ASAP with warm water to restore blood flow and reduce tissue
damage for at least 30 minutes or until the area turns pink
○ Once rewarming has been effect, the child should be seen by an HCP ASAP
● Acne
○ Non Comedogenic skin care products should be used to avoid creating new
lesions
● Burns
○ Priority action is to stop the burning process and to ensure that the child is not
exhibiting signs of impending airway compromise
○ Actions to take before going to the ED: administer acetaminophen or ibuprofen,
briefly run cool or lukewarm water over the burn, lightly cover the burn area with
nonadhesive bandages to minimize infection risk, quickly remove any clothing or
jewelry around the area

Musculoskeletal
● Duchenne muscular dystrophy- x linked recessive disorder that causes the progressive
replacement of dystrophin, a protein needed for muscle stabilization
○ Proximal lower extremities and pelvis are the first to be affects, and in response to
proximal weakness, the calf muscles hypertrophy
○ S/sx: gower sign (placing hands on thighs to push up and stand), enlarged calves,
walking on tip toes and frequent tripping/ falling
○ Avoid floor clutter to prevent falls/ injury
● Club foot- a congenital bone deformity and soft tissue contracture manifested by one or
both feet being turned inward
○ Management: HCP manipulates/ stretches the affected food and places it in a long
cast, weekly recasting over 5-8 weeks is necessary
○ Teaching: monitoring circulation, keeping cast dry, cast will need to be replaced
weekly every 5-8 weeks
● Compartment syndrome
○ 6 P’s
■ Pain, pressure, paresthesia, pallor, pulselessness, paralysis
● Developmental Dysplasia of the Hip (DDH)- instability or dislocation of the hip joint that
may be present at birth or develop during the first few years of life
○ Pavlik harness- the most common tool used to treat DDH. Maintains the infant’s
hips slightly flexed and abducted (bent and spread apart) and are work for 3-5
months or until the hip joint is stable
■ Straps are assessed Q1-2wks per HCP and adjusted as necessary to
account for infant growth, parents should not alter the strap placements,
assess skin 2-3x daily, dress the child in a shirt and knee socks under the
harness, apply diapers underneath straps, leave harness on at all times,
lightly massage the skin under the straps daily
○ Manifestations
■ 2-3 months: presence of an extra inguinal or thigh folds, Barlow and
Ortolani maneuvers revealed laxity of the hip joint
■ >3 months: limited hip adduction, the affected leg may be shorter than the
opposite leg, positive trendelenburg sign (pelvis tilts down on unaffected
side when standing on the affected leg)
○ Prevention
■ swaddle with hips bent up (flexion) and out (abducted), infant carriers or
car seats with wide bases, avoid positioning device, seat, or carrier that
causes hip extension with the knees straight and together
● Osteogenesis imperfecta (brittle bone disease)- a rare genetic condition resulting in
impaured synthesis of collagen by osteoblasts
○ Care of an infant: checking blood pressure manually, lifting the infant by slipping
a hand under the broadest areas of the body (back, butt), repositioning infant
frequently using supportive devices and gel padding
● Scoliosis- characterized by lateral curvature of the spine and spinal rotation
● Dental avulsion- separation of permanent tooth from the mouth
○ Priority is to reinsert the tooth into the gingival socket and hold it in place until
stabilized by a dentist
○ Reimplantation within 15 minutes of injury re-establishes blood supply,
increasing the probability of tooth survival
 ■ If the tooth cannot be reinserted, it should be kept moist by submerging it
in commercially prepared solution, cold milk, sterile saline, or as a last
resort under tongue
○ Client should see dentist immediately

Neuro
● Increased intracranial pressure (ICP)
○ Result of obstruct in CSF flow
○ S/sx: bulging fontanelles, increasing
head circumference, sunset eyes
● Bacterial meningitis- inflammation of the
meninges in the brain and spinal cord that is
caused by specific types of bacteria
○ Clinical manifestations <2 y/o:
fever/ possible hypothermia,
irritability, seizures, high pitched cry,
poor feeding and vomiting, nuchal
rigidity, bulging fontanelle possible
○ Acute complications: hydrocephalus
○ Long term complications: hearing
loss, learning disabilities, and brain
damage
○ Tx: antibiotics ASAP
● Myelomeningocele- occurs when the neural tube fails to fuse properly during fetal
development. An outpouching of spinal fluid, spinal cord, and nerves covered by only a
thing membrane occurs, typically in the lumbar area
○ Nursing interventions: priority ro cover the area with a sterile, moist dressing to
decrease the risk of infection until surgical repair can occur
● Ventriculoperitoneal shunt- used to treat hydrocephalus and is usually placed at age 3-4
months
○ Blockage and infection are complications
■ Blockage results in increased ICP (s/sx: vomiting)
● Seizure precautions
○ Turn client on side, oral suction, supplemental O2, pad the side rails
○ Avoid restraints
● Electroencephalogram (EEG)- diagnostic procedure used to evaluate the presence of
abnormal electrical discharges in the brain, which may result in seizure disorder
○ Parent teaching: wash hair before, wash after to remove electrode gel, avoid
caffeine, stimulants, ans CNS system depressants prior to the test, test is not
painful
Respiratory
● Bronchiolitis- common viral illness usually caused by RSV
○ S/sx: rhinorrhea, congestion → tachypnea, coughing, wheezing
○ Teaching: continue breastfeeding, use saline nose drops, then suction nares prior
to feedings and bedtime, offer additional fluids
● Cystic Fibrosis (CF)- inherited disorder characterized by thickened secretions due to
impaired chloride and sodium channel regulation that causes exocrine gland dysfunction
○ Complications
■ Pulmonary: respiratory infections, sinusitis, chronic hypoxemia
■ GI: malabsorption of fat soluble vitamins (A, E, D, K) and other
nutritional deficiencies, high calorie/ protein foods and supplemental
enzymes with meals are necessary
■ Reproductive: infertility
■ Manual CPT should be performed if the vest (high frequency chest wall
oscillation) is not available
○ Teaching: pancreatic enzyme supplements, diet high in carbs, protein, and fat,
increased salt intake during hot weather, do not limit child’s participation in
sports, discuss financial needs, aerobic exercise
● Asthma
○ Silent asthma- frequent cough at night, sometimes to the point of throwing up=
○ Triggers: smoke, dander, cockroach feces, air pollution, hay fever, food allergies
○ No wheezing during exacerbation = emergency
○ Peak expiratory flow determines severity of asthma exacerbation
○ Oxygen saturation is the best indicator of treatment effectiveness as it reflects gas
exchange
● Epiglottitis
○ Should be considered first in a 3-7 y/o with acute respiratory distress, toxic
appearance (drooling, sitting up, leaning forward), stridor, high grade fever,
tachycardia, and tachypnea
○ Considered an emergency and should be handled with ET intubation
○ Placing child in tripod position opens the airway and helps air flow
○ Prevented by standard immunizations
Urinary/ Renal
● Wilms tumor (nephroblastoma)- kidney tumor that usually occurs in children <5
○ Unusual contour of the abdomen
○ Once diagnosis is confirmed, the abdomen should not be palpated
○ Handle child carefully during bathing
● Nephrotic syndrome- an autoimmune disease, affecting ages 2-7 y/o, that is characterized
by increased permeability of the glomerulus proteins (albumin, immunoglobulins, natural
anticoagulants)
 ○ Hypoalbuminemia→ decreased oncotic pressure → edema, weight gain, loss of
appetite, decreased urine output
○ Susceptible to infection → limit visitors
○ Tx: corticosteroids, loss of appetite management, infection prevention
● Hypospadias- congenital defect in which the urethral opening is on the underside of the
penis
○ Circumcision is delayed so the foreskin can be used to reconstruct the urethra to
the penis tip
○ Post op care: client will have a catheter or stent to maintain patency, urinary
output is important indication of urethral patency, fluids are encouraged, absence
>1hr post op → notify provider
● Acute glomerulonephritis- an immune complex disease most commonly induced by a
prior group A beta hemolytic streptococcal infection of the skin or throat
○ Clinical manifestations: periorbital and facial/generalized edema, HTN, oligura,
tea colored urine d/t presence of blood
○ Monitor BP closely
○ Daily weights
Visual/Auditory
● Acute otitis media- infection of the middle ear resulting is dysfunction of the eustachian
tube
○ Newborns- 2y/o
○ Clinical manifestations: high fever, ear pain, irritability/ restlessness, loss of
appetite, pulling on the affected ear, tympanic membrane bulging and very red
○ S/sx tympanic membrane ruptured: immediate pain relief, gradually decreasing
fever, purulent drainage from ear
○ If symptoms do not improve 48-72H after starting antibiotics therapy, the client
should return for further assessment
○ Potential combinations: conductive hearing loss, child may need hearing
screening after the infection resolves to assess hearing changes
○ Do not insert speculum into the bony interior part of the ear canal, encourage
parents to vaccinate against influenza and pneumonia, inspect the tympanic
membrane redness, bulging, and perforation, and wait until the end of the
assessment to perform the otoscopic examination
● Otitis externa- infection of the outer ear
○ Severe pain experienced with direct pressure on the tragus or with pulling on the
pinna
○ Prevent through decreasing exposure to tobacco, lessen pacifier usage, do not
drink from bottle while lying down, obtain routine immunizations
● Myopia- nearsightedness
○ Headaches, dizziness, need to squint the eyes to see clearly
● Retinoblastoma- unilateral or bilateral tumor; most common childhood intraocular
malignancy
○ White glow of the pupil is most recognizable symptom when exposed to light
reflecting off of it
○ Strabismus (cross eyed) is the second most common sign
● Hearing impairment
○ S/sx: child appears withdrawn from social interaction, inattentive when given
directions, monotone speech, difficult to understand, loud voice, increased use of
gestures and facial expression
● Strabismus- crossed eyes
○ If left untreated by age 4-6, permanent reduction or loss of visual acuity in the
affected eye
○ Tx: depends on underlying cause, patch over unaffected eye, corrective lenses,
surgical intervention to shorten or reposition an eye muscle
● Visual acuity
○ Snellen letter chart
■ Position chart 10 ft from the chart and asked to read the letters